Medicare Claims Analyst Resume Example Company Name

MEDICARE CLAIMS ANALYST

Work History

Medicare Claims Analyst, 07/2014 to 09/2016
Company Name – City, State

Confidently handled denials/appeals for outpatient/inpatient claims billed incorrectly or under paid.

Posted and adjusted payments received from insurance carrier.

Submitted electronic/paper claim documentation for timely filing.

Interacted with providers and other medical professionals regarding billing/procedures/government regulations.

Reviewed incorrectly billed claims to identify more appropriate coding based on CMS Regulations and guidelines.

Researched CPT and ICD-9/ ICD-10 coding discrepancies for compliance and reimbursement accuracy.

Actively maintaining knowledge of CPT/ICD-9/ICD-10 coding principles, government regulation, CMS guidelines, billing processes, coding requirements, through continuing education and certification renewals.

Claim Researcher , 12/2011 to 07/2014
Company Name – City, State

Rectified problems concerning coverage/billing to ensure pharmacy needs were properly met for patient/facility.
Verified patient eligibility, coverage and claim status with insurance carrier.
Trained new hires on system/programs/position requirements until full understanding of all processes.
Obtained prior authorizations for coverage on patient\'s medications.
Managed collection against estate of deceased patient.
Evaluated financial status to appropriately set payment plans for patient.
Treated patients, family members, pharmacy/facility staff and carrier reps with courteous, professional manner.
Offered detailed explanation of plan coverage/processes, above job description, to provide excellent customer service.
Acknowledged by management; received customer appreciation regularly.
Awarded multiple times for excellent customer service.

Professional Summary

Medical Billing and Coding Specialist with 7 years experience. Strong ability to identify denied/under paid claim items needing appeal/correct claim. Organized professional able to adapt to changes within the Billing and Coding profession. Knowledge and experience to interpret contract language between provider/carrier.

Skills

Education, Training and broad knowledge of ICD-9/ICD-10, CPT procedure coding, Revenue codes, Condition codes, DRG assignments, Medicare PC pricers
Inpatient and outpatient coding proficiency
Experience with Traditional Medicare, Medicare Advantage, Commercial, RX coverage plans
HCPCS Coding Guidelines

Composed and professional demeanor with excellent customer service skills
Billing and collection procedures experience
DRG assignment, PC Medicare pricer training, including outpatient grouping and codes
Medical terminology knowledge, ability to read and understand medical records, interpret contract language

Education

Medical Claims and Billing degree : 2009
U.S. Career Institute -

Resume Overview

School Attended

U.S. Career Institute

Job Titles Held:

Medicare Claims Analyst
Claim Researcher

Degrees

Medical Claims and Billing degree : 2009

Medicare Claims Analyst Resume Example

Resume Score: 65%

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